ity s r PTcidd.unc.edu/docs/lend/LowerExtremityOrthosesAPrimer.pdfDifferent types of orthosis !...
Transcript of ity s r PTcidd.unc.edu/docs/lend/LowerExtremityOrthosesAPrimer.pdfDifferent types of orthosis !...
Lower Extremity
Orthoses: A Primer
ABBY AMPIL, PT, DPT
Outline
! Define orthosis
! Common reasons to use an orthosis
! Different types of orthosis
! Design
! Rationale and indications
! Review additional considerations
What is an orthosis?1
! Externally applied device that is designed and fitted to the body to achieve one or more of the following goals:
! Control biomechanical alignment
! Correct or accommodate deformity
! Protect and support an injury
! Assist rehabilitation
! Reduce pain
! Increase mobility
! Increase independence
Why do YOU care?
! Your kids may have orthoses!
! Familiarity of language
! General understanding of rationale
! Be able to help take them off/on
Get ready for acronyms!!
! UCBL
! University of California Biomechanics Laboratory
! SMO
! Supramalleolar orthosis
! AFO
! Ankle foot orthosis
! KAFO
! Knee ankle foot orthosis
! FRAFO
! Floor reaction ankle foot orthosis
Types of orthoses
! Foot orthosis
! UCBL
! SMO
! Posterior Leaf Spring AFO
! Hinged AFO
! Solid AFO
! Floor Reaction
! KAFO
Reasons to use an orthosis2 ! Improves stability during walking by blocking problematic joint
motions
! Improve foot clearance (not catching feet on the floor) by assisting joint motions
! Improves efficiency of gait pattern to minimize energy expenditure
! Preventing deformity and secondary orthopedic issues by providing optimal skeletal alignment
! Preventing contracture (muscle shortening) by holding a joint in position where the muscle is lengthened
Foot Orthosis (FO)3
! Indication:
! Arch support in patients who are pronated (flat feet)
UCBL3
! Indications:
! Arch and heel support
! Higher level of support than foot orthoses
SMO3
! Can help control pronation (flat feet) AND supination (arches too high)
! Relatively rigid control, but ankle and knee motion still allowed
Posterior Leaf Spring AFO2,3
! Controls foot drop (toe pointing down)
! Allows the ankle to come forward when the foot is on the ground during walking
! Helps push foot off the floor before it swings through
Hinged AFO2,3
! Very versatile design; can add stops or springs to block or assist many different motions at ankle or knee
! Commonly used to prevents walking up on toes, while still allowing the ankle to come forward
Solid AFO2,3
! Locks ankle in a fixed position
! Prevents walking on toes
! Prevents “crouch gait” (hips and knees bent, ankle forward)
! Prevents drop foot
! Prevents hyperextension at knees
! Can be used at rest to prevent calf muscle shortening
Floor Reaction AFO2,3
! Designed to prevent crouch gait (knee buckling)
KAFO2,3
! Commonly used in paralysis or profound weakness
! Locks at knee joint keep it straight when upright, but unlock to allow sitting
! Typically used alongside an assistive device (crutches or walker)
! Can be used at rest to prevent calf and hamstring muscle shortening
Additional considerations3
! Possible issues
! Overbracing
! Underbracing
! How long do they wear the brace for?
! Lifespan of brace
! Fit issues
! Day vs. night use
https://www.youtube.com/watch?v=sPctE4DFpdU
Movie time!
Questions?
THANKS!
References
! 1. About ortheses and prostheses. (n.d.). Retrieved April 1, 2016, from https://www.aopa.org.au/careers/what-are-orthoses-and-prostheses
! Novacheck, T. F., Kroll, G. J., Gent, G., Rozulmalski, A., Beattie, C., & Schwartz, M. H. (2009). Orthoses. In Gage, J.R., Schwartz M.H, Koop S.E., Novacheck, T.F. The Identification and Treatment of Gait Problems in Cerebral Palsy (pp. 327-348) (2nd ed.). London: Mac Keith Press.
! 3. Foundations of Pediatric Orthotics. (n.d.). Retrieved April 1, 2016, from https://pediatricapta.org/includes/fact-sheets/pdfs/Orthotics.pdf